Sports Medicine · Knee
Fellowship-trained ACL surgery using bone-patellar tendon-bone and quadriceps tendon grafts, with anterolateral ligament (ALL) reconstruction for high-risk patients to significantly reduce the chance of retear. Serving Platteville, WI, Dubuque, IA, and the tri-state region.
About ACL Reconstruction
The anterior cruciate ligament (ACL) is the primary stabilizer of the knee against rotational and anterior forces. ACL tears are among the most common serious sports injuries, affecting athletes and active individuals of all ages — from high school athletes to recreational weekend players.
Unlike some ligaments, the ACL does not reliably heal on its own. For patients who want to return to cutting, pivoting, or high-demand activities, reconstruction is the standard of care. Dr. Strassman performs ACL reconstruction arthroscopically, using the patient's own tissue (autograft) to rebuild a strong, anatomic ACL.
His approach prioritizes graft selection individualized to each patient, anatomic tunnel placement, and adjunctive procedures where evidence supports improved outcomes — including lateral extra-articular tenodesis in high-risk patients.
Signs You May Have Torn Your ACL
A "pop" felt or heard at the time of injury
Rapid swelling within hours of injury
Feeling of knee "giving way" during activity
Inability to continue playing after a non-contact pivoting injury
Instability with stairs, cutting, or direction changes
Surgical Technique
Dr. Strassman uses two primary autograft options for ACL reconstruction — bone-patellar tendon-bone (BTB) and quadriceps tendon. Graft choice is individualized based on the patient's age, sport, activity demands, anatomy, and any concurrent injuries.
The BTB graft uses the central third of the patellar tendon with bone plugs at each end. The bone-to-bone healing at both fixation points allows for some of the strongest and most reliable early fixation available, with an extensive long-term track record in high-demand athletes.
BTB is frequently preferred for competitive athletes who participate in cutting and pivoting sports where rotational demands on the graft are highest.
The quad tendon graft has emerged as a leading option in modern ACL surgery. It offers a larger cross-sectional area than patellar tendon, less anterior knee pain, and can be harvested with or without a bone plug. Growing evidence supports excellent outcomes particularly in revision cases and larger patients.
Dr. Strassman selects quad tendon for patients where patellar tendon harvest would pose increased risk, or when a larger graft diameter is advantageous.
Advanced Technique
ACL retear rates — particularly in young athletes returning to pivoting sports — remain a meaningful clinical problem, with some studies reporting retear rates of 15–25% in patients under 25 returning to sport. Dr. Strassman routinely adds a lateral extra-articular tenodesis (LET) for patients at elevated risk.
LET is a procedure performed on the outside (lateral) aspect of the knee that augments rotational stability — the specific force the ACL graft is most vulnerable to. By sharing rotational load with the graft, LET reduces strain on the reconstructed ACL during the critical early healing phase when graft strength is at its lowest.
Dr. Strassman performs LET using an ALL (anterolateral ligament) reconstruction technique — reconstructing the anterolateral ligament of the knee using a separate graft or tissue, rather than a soft tissue tenodesis. This provides a more anatomic and durable augmentation of rotational stability compared to traditional IT band-based LET techniques.
The STABILITY trial (2022) — a high-quality randomized controlled trial — demonstrated that adding lateral extra-articular augmentation to BTB ACL reconstruction reduced graft failure rates by approximately 40% in young active patients at 2 years. This evidence directly informs Dr. Strassman's practice.
Younger patients (<25), high-demand pivoting sport athletes, patients with generalized ligamentous laxity, and those with a steep lateral tibial slope — all factors associated with higher retear risk.
Dr. Strassman uses ALL reconstruction — an anatomic reconstruction of the anterolateral ligament — rather than a traditional IT band tenodesis. This approach restores the native restraint to internal tibial rotation more precisely and durably.
ALL reconstruction adds minimal time to the procedure and does not significantly change the rehabilitation protocol. Return-to-sport timelines remain similar to standard ACL reconstruction alone.
Rehabilitation
ACL reconstruction recovery is milestone-based, not simply time-based. Return to sport is cleared based on strength testing, functional assessments, and clinical evaluation — not a calendar date alone.
Ice, elevation, and early range of motion exercises. Weight bearing as tolerated. Quad activation is the primary early goal.
Progressive closed-chain strengthening, stationary bike, gait normalization. Brace weaned as quad control improves.
Single-leg balance, proprioception training, light jogging introduced when quad strength criteria are met.
Progressive running program, sport-specific agility drills, cutting and change of direction introduced based on strength symmetry testing.
Return to unrestricted sport typically at 9 months minimum for cutting/pivoting athletes, contingent on passing functional strength testing (LSI ≥90%).
Common Questions